Case Report : Multiple Stress Fractures (hamate, triquetrum, 2nd, 3rd, and 4th Metacarpal bones) in an Amateur Tennis Player

Hatim Mohammed A Alshareef,Alhusain Mohammad Alshareef,Mohammed Hussein Alkaff

doi:10.24018/ejmed.2020.2.3.274

Abstract

Background: upper extremity stress fractures are infrequent events in tennis sport. According to our literature, we have only identified 6 case reports of upper limb stress fractures among amateur or professional tennis players. To the best of our knowledge, this is the only case report where stress fractures occur in: hamate, triquetrum, 2nd, 4th, and 5th metacarpal bones simultaneously.  Case presentation: 27 years old lady, presented with acute burning pain at the base of her right thumb. There was not a history of direct trauma. Her symptoms start to appear after 3 days of playing tennis. Physical examination was negative for tenderness, swelling and erythema. The rheumatoid factor was elevated (20.3 iu/ml). the diagnosis of multiple stress fractures was made by the suggestive MRI findings.  Conclusion: Although stress fractures of the upper limbs are not common, it is of a great value to keep the clinical suspicion high towards it. Especially in amateur or professional athletes with persistent or worsening symptoms. The best modality to confirm such fractures is MRI.

Highlights

Upper extremities stress fractures are considered rare incidences in the field of sports medicine [1,2,3,4,5]
Conclusion: stress fractures of the upper limbs are not common, it is of a great value to keep the clinical suspicion high towards it
The physical examination was generally unremarkable since no swelling or erythema was detected

Summary

Conclusion

Stress fractures of the upper limbs are not common, it is of a great value to keep the clinical suspicion high towards it. In amateur or professional athletes with persistent or worsening symptoms. The best modality to confirm such fractures is MRI. The physical examination was generally unremarkable since no swelling or erythema was detected. Laboratory investigations revealed an elevated Rheumatoid factor (20.3 iu/ml). The diagnosis of multiple stress fractures was made upon MRI findings. X-ray was unremarkable (Figure 1 and 2). MRI showed multiple areas of bone marrow edema at the base of the 2nd, 4th, 5th metacarpal bones as well as hamate and triquetrum bones (Figure 3 and 4)

INTRODUCTION

CASE REPORT:

CONCLUSION

DISCUSSION